Improving Wrist Injury Pathways (I-WIP): a qualitative study
Research type
Research Study
Full title
Improving Wrist Injury Pathways (I-WIP): a qualitative study
IRAS ID
321650
Contact name
Benjamin Dean
Contact email
Sponsor organisation
Research Governance and Ethics Team, University of Oxford
Duration of Study in the UK
2 years, 0 months, 0 days
Research summary
Research Summary:
Wrist injuries represent a considerable problem for both patients and the NHS. Around 70,000 patients per year in the UK attend hospitals with serious wrist pain after an injury, only to find that their x-ray is considered to be ‘normal’. The National Institute of Care and Health Excellence (NICE) advises that these patients should be given MRI (magnetic resonance imaging) scans early on, within 2 weeks. Early MRI gives patients the best care, by picking up the serious injuries requiring early treatment and by helping reassure those without serious injuries to get back to activities quickly. This saves the NHS staff time and money by reducing unnecessary clinic attendances. Although these benefits from early use of MRI scans, and the NICE guidance, are clear, we know from our recent national (UK) survey that only 11 of the 87 UK hospitals that we surveyed used MRI scans for these patients.
The gap between what the best evidence suggests and what happens in clinical practice is a complex issue that requires further investigation. To develop a complex intervention to address this problem, we need a far better understanding of the reasons why hospital services are currently unable to adopt the NICE guidance. In 2000, the UK Medical Research Council (MRC) established guidance for developing and evaluating complex interventions to improve the delivery of health care services. An important stage in developing complex interventions and improving care is to fully understand current pathways and the context of care. This qualitative study aims to develop a better understanding of wrist injury pathways, and their context, in the NHS. We aim to (1) understand the barriers to early MRI for painful wrists and (2) understand what is important to patients when being treated with a wrist injury.
Summary of Results:
The use of early MRI (Magnetic Resonance Imaging) scans varies in the management of wrist injuries in the UK. Now, only a minority of NHS centres can offer this to patients in their ‘pathway’ of care.
In this study, we explored the views of staff and patients on the use of early MRI in the treatment of wrist injuries. We interviewed a sample consisting of 37 NHS staff members and 21 patients.
Analysing what people said in these interviews, we grouped the results into three key ideas:
• The first idea described the negative impact that wrist injuries had. The consequences of missing certain fractures were described as a horrible thing for patients, while some patients described how they had to accept that their wrist may never be the same again.
• The second idea described how early use of MRI scans were seen as a win for everyone. For patients, the win was the relief of a speedy diagnosis and a clear early treatment plan, which they felt helped them get better quicker. Staff saw early use of MRI as a win because it revolutionised care for patients and reduced the number of clinic attendances needed.
• The final idea defined the key ingredients to getting an early MRI pathway working:
o keeping it simple
o getting enough MRI scanning slots
o reporting the results of the scans fast
o a safe pathway which could not lose patients
o using data to check that things are done on time
o clear communication and caring within teams.
Our findings contribute to a better understanding of what patients and NHS staff think about wrist injury pathways in the NHS.REC name
South Central - Oxford A Research Ethics Committee
REC reference
23/SC/0118
Date of REC Opinion
19 Apr 2023
REC opinion
Further Information Favourable Opinion